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Severe acute multi-systemic failure with bilateral ocular toxoplasmosis in immunocompetent patients from urban settings in Colombia: Case reports.

ABSTRACT: Propose:To report two cases of severe acute multi-systemic failure with bilateral ocular toxoplasmosis in immunocompetent patients from urban settings in Colombia. Observations:We report two immunocompetent male patients aged 44- and 67-years-old who, despite not having visited the Amazonian region in Colombia, had severe bilateral posterior uveitis and extensive-bilateral macular lesions and multiple organ failure that required admission to an intensive care unit. Toxoplasma gondii was positive by PCR assay in vitreous humor samples. Patients were treated with intravitreal clindamycin and dexamethasone in addition to systemic treatment with trimethoprim-sulfamethoxazole. In both patients, infection by atypical strains was confirmed; in one case by serotyping and in another one by genotyping (ROP 18 virulent allele). After 2 and 4 months of treatment respectively, the patients showed improvement of the posterior uveitis and its systemic manifestations. However, there was no significant visual acuity improvement due to bilateral extensive macular involvement. Conclusions and importance:Clinicians should be aware that toxoplasmosis originating from South America could be associated with severe acute multisystemic and intraocular bilateral involvement, even in patients with no history of exposure to jungle environments.

SUBMITTER: Cortes DA

PROVIDER: S-EPMC7078491 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Severe acute multi-systemic failure with bilateral ocular toxoplasmosis in immunocompetent patients from urban settings in Colombia: Case reports.

Cortés Diana Alejandra DA Aguilar María Camila MC Ríos Hernán Andres HA Rodríguez Francisco José FJ Montes Kelly Verónica KV Gómez-Marín Jorge Enrique JE de-la-Torre Alejandra A

American journal of ophthalmology case reports 20200313

<h4>Propose</h4>To report two cases of severe acute multi-systemic failure with bilateral ocular toxoplasmosis in immunocompetent patients from urban settings in Colombia.<h4>Observations</h4>We report two immunocompetent male patients aged 44- and 67-years-old who, despite not having visited the Amazonian region in Colombia, had severe bilateral posterior uveitis and extensive-bilateral macular lesions and multiple organ failure that required admission to an intensive care unit. <i>Toxoplasma g ...[more]

PMID: 32195446

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Project description:BackgroundPrevious studies suggest a relationship between precipitation and ocular toxoplasmosis (OT) reactivation and congenital toxoplasmosis infection. We aimed to investigate the relationship between precipitation and the frequency of new OT cases in Colombia from 2015 to 2019.MethodologyThis retrospective cohort study analyzed data obtained from a claims-based database created by the Colombian Ministry of Health and national registries of precipitation of the Institute of Hydrology, Meteorology, and Environmental Studies. We estimated the daily number of OT cases, interpolating data from the average number of annual cases from 2015 to 2019. Then, we compared exposures (mean daily precipitation) in the case period in which the events (interpolated OT new cases) occurred by a quasi-Poisson regression, combined with a distributed lag non-linear model to estimate the non-linear and lag-response curve.Principal findingsIn the 5-year analysis, there were 1,741 new OT cases. Most of the cases occurred in 2019, followed by 2015 and 2018. New OT cases among departments were significantly different (P< 0.01). The cumulative exposure-response curve was decreasing for most departments. Nevertheless, in Chocó, Bogotá, Cesar, Cauca, and Guajira, when a certain amount of precipitation accumulates, the relative risk (RR) increases, which was contrary to the pattern observed in the other regions. The response curves to the one-day lag showed that precipitation influences the RR; however, the trends vary by department. Finally, an increasing trend in the number of cases was directly proportional to precipitation in Guajira, Atlántico, Norte de Santander, Santander, Caquetá and Quindío (r = 0.84; P< 0.05).ConclusionsPrecipitation influenced the RR for new OT cases. However, varying trends among geographical regions (departments) lead us to hypothesize that other sociodemographic, behavioral, and environmental variables, such as wind and water contamination, could influence the RR.

Dataset Information

Severe acute multi-systemic failure with bilateral ocular toxoplasmosis in immunocompetent patients from urban settings in Colombia: Case reports.

Publications

Severe acute multi-systemic failure with bilateral ocular toxoplasmosis in immunocompetent patients from urban settings in Colombia: Case reports.

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